On the Verge of Understanding

Advances in the treatment of metastatic colorectal cancer have tripled survival rates, but more profound leaps are anticipated as researchers unravel the disease's complexities.
BY ERIK NESS
PUBLISHED: APRIL 08, 2015
As Rachel Lefebvre approached a certain age, she began to take heed of the advice of a few older friends. Forty, they warned—in that half-joking way—was a tipping point after which everything went downhill. She vowed to enter the decade in fighting form, and began eating better and exercising regularly. For a while she felt great, but as she crossed the threshold of her milestone year, exhaustion set in.

Soon she wound up at her doctor, wondering aloud about vitamin deficiency. Instead, some funky liver enzyme readings led to a precautionary ultrasound, which escalated to an MRI, which resulted finally in a biopsy and a diagnosis of metastatic colon cancer.

There is no whiplash like discovering stage 4 cancer at 40. “It was so surreal,” she says 18 months later, recovering from an advanced radiation treatment called Y-90 (intra-arterial yttrium-90 radioembolization) that’s gaining favor in the treatment of metastatic disease to the liver. Doctors placed radioactive beads not much larger than red blood cells into tumors in her liver. Now she’s contemplating her next medical steps.

She fired her first doctor, who told her she spent too much time on Google. “Wouldn’t you?” she countered. “You gave me two years and I have two kids. There is no way I’m not doing everything and anything I can to outlive this.”

Empowered by the engaged stage 4 patients she found in the online forums at Colon Town (chris4life.org/colontown), she found a doctor three hours away at an academic medical center in Central Florida. Now she has options.

Colorectal cancer is an interesting example of both how far cancer treatments have advanced, and how far they still need to go. Patients with stage 4 colorectal cancer used to survive an average of just nine months; that number now hovers around 30 months.

But while incremental advances in treatment have nearly tripled survival time for those with advanced disease over the last two decades, colorectal cancer is still waiting for its miracle. Drugs like Herceptin (trastuzumab) for breast cancer have turned certain subtypes of cancer from lifethreatening diseases into conditions that can be managed for years.

“We are jealous of some of the other cancers,” says oncologist John Marshall, director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer at Georgetown University.

Researchers have been refining their treatments, and that’s been a key to the improving outcomes. But: “That’s different than finding what makes the cancer tick,” he says. “Right now, we are measuring one street corner and saying that we understand the traffic. We are measuring one gene when we know that there are multiple genes involved. We need to understand more.”

But intriguing biological clues point to complexities we’re on the verge of understanding. For example, preliminary indications are that, after diagnosis, eating a non-Western diet and exercising both increase a patient’s chance of survival. More curiously, whether the cancer appears on the left or right side of someone’s body is a clue to its origin.

Colon cancers on the right side tend to be hereditary, while those on the left side tend to be sporadic. Scientists hypothesize that it may be about how intestinal bacteria help break down food, changing its chemistry as the waste passes toward the toilet.

TREATMENT BY STAGE

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